Table 3 Solutions of EDs crowding

Organization or management level solutions

• Executive leadership involvement, hospital-wide coordinated strategies, data-driven management, and performance accountability [90]

• Implementing emergency patient transfer network system (RTNS) [91]

• Implementing Lean/Six Sigma Method [92]

• Implementing an independent capacity protocol [93, 94]

• Forecasting ED crowding [95]

Operational level solutions

a. Staffing and motivation

• Pay for performance [96]

• Staffing ED with qualified professionals [97, 98]

b. Operational level strategies and tactics

• Developing evidence-based admission criteria [21]

• Implementing Electronic Blockage System (EBS) [99]

• Implementing smoothing strategy [100]

• Using capacity alert escalation calls [20]

• Applying Discrete Event Simulation (DES) model [22]

• Improving leadership of ED [101]

• Implementing contingency strategy [102]

• Using management-support multimodal hospital-wide interventions [103]

• Implementing four-hour-rule for emergency care [104]

• Introducing of Stat Lab [105]

• Implementing Code Help Regulation [106]

• Using a dashboard to provide real-time information about crowding [107]

c. Service delivery process

• Acute care emergency surgery service provision [108]

• Whole week emergency service delivery [109]

• Implementing triage by physicians [110]

• Introducing efficient patient discharging process [111]

• High-turnover utility bed management [112]

• Implementing Timely Quality Care [113]

• Implementing an improved ED patient flow [114]

d. Other services

• Enhanced primary care [21, 115]

• Optimizing translation services [21]

e. Premises

• Expanding or opening additional EDs [116, 117]

• Hallway emergency bed [9]

• Increasing hospital bed capacity [118]